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        <h1>
            Hepatitis</h1>
        <h5 class="updated">
            Last updated: Saturday, 04, December, 2010</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Causes</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                </td>
                <td class="second">
                    <p>
                        <b>AST, ALT (with AST/ALT ratio), GGT, ALP, LD, bilirubin, albumin, protein 
                        (total); urinalysis; FBC, blood film; PT.</b></p>
                    <p>
                        <b>Liver biopsy</b>, if indicated.</p>
                    See also
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=304&amp;Itemid=27" 
                        target="_blank">Hepatic failure</a></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <strong>Acute</strong></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection, especially</p>
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=306&amp;Itemid=27" 
                                target="_blank">Hepatitis A virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=307&amp;Itemid=27" 
                                target="_blank">Hepatitis B virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=308&amp;Itemid=27" 
                                target="_blank">Hepatitis C virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=309&amp;Itemid=27" 
                                target="_blank">Hepatitis D virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=310&amp;Itemid=27" 
                                target="_blank">Hepatitis E virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=370&amp;Itemid=27" 
                                target="_blank">Infectious mononucleosis</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=175&amp;Itemid=27" 
                                target="_blank">Cytomegalovirus infection</a></li>
                        <li>Q fever</li>
                        <li>Leptospirosis</li>
                        <li>Alcoholic hepatitis</li>
                    </ul>
                </td>
                <td class="second">
                    <p>
                        &nbsp;</p>
                    <p>
                        &nbsp;</p>
                    <p>
                        &nbsp;</p>
                    <p>
                        &nbsp;</p>
                    <p>
                        &nbsp;</p>
                    <p>
                        See under
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                            target="_blank">Alcoholism</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Drugs, especially</p>
                    <ul>
                        <li>Paracetamol</li>
                        <li>Flucloxacillin</li>
                        <li>Amoxycillin/Clavulanate</li>
                        <li>Anabolic steroids</li>
                        <li>Isoniazid</li>
                        <li>Anticonvulsants, especially
                            <ul>
                                <li>Valproate</li>
                            </ul>
                        </li>
                        <li>NSAID</li>
                        <li>Halothane</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Hepatic ischaemia</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <strong>Chronic</strong></p>
                </td>
                <td class="second">
                    <p>
                        The severity (grade) and degree of fibrosis (stage) are determined on <b>liver 
                        biopsy.</b></p>
                    <p>
                        To monitor progress: <b>AST, ALT, ALP, GGT, total protein, albumin.</b></p>
                    <p>
                        Elevated <b>serum immunoglobulins</b> (IgG, IgA) and&nbsp;ß-gamma&nbsp;bridging on protein 
                        electrophoresis support the diagnosis of chronic hepatitis. Immunoglobulins (G, 
                        A, M) - serum or protein electrophoresis are also useful to distinguish the 
                        various causes of chronic hepatitis.</p>
                    <p>
                        A markedly raised IgM supports the diagnosis of primary biliary cirrhosis.</p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection, especially</p>
                    <ul>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=307&amp;Itemid=27" 
                                target="_blank">Hepatitis B virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=308&amp;Itemid=27" 
                                target="_blank">Hepatitis C virus infection</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=309&amp;Itemid=27" 
                                target="_blank">Hepatitis D virus infection</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Autoimmune hepatitis&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        <b>Smooth muscle antibodies, antinuclear antibodies, mitochondrial antibodies, 
                        liver/kidney microsomal antibodies.</b></p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Alcoholic hepatitis&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        See under&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=43&amp;Itemid=27" 
                            target="_blank">Alcoholism</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Drugs, especially</p>
                    <ul>
                        <li>Flucloxacillin</li>
                        <li>Amoxycillin/Clavulanate</li>
                        <li>Isoniazid</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Wilson&#39;s disease</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        α1-antitrypsin deficiency&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        <b>Alpha-1-antitrypsin.</b></p>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Primary biliary cirrhosis&nbsp;</p>
                </td>
                <td class="second">
                    <p>
                        See under&nbsp;<a 
                            href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=137&amp;Itemid=27" 
                            target="_blank">Cirrhosis</a>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Primary sclerosing cholangitis</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <strong>Granulomatous&nbsp;</strong></p>
                </td>
                <td class="second">
                    <p>
                        Diagnosis requires liver biopsy.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Idiopathic</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Sarcoidosis</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Drugs, especially</p>
                    <ul>
                        <li>Allopurinol</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Infection, especially</p>
                    <ul>
                        <li>Q fever</li>
                        <li>Brucellosis</li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=764&amp;Itemid=27" 
                                target="_blank">Tuberculosis</a></li>
                        <li><a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=100&amp;Itemid=27" 
                                target="_blank">Candidiasis</a></li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=323&amp;Itemid=27" 
                            target="_blank">Hodgkin&#39;s disease</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd-last">
                <td class="first">
                    <p>
                        Berylliosis</p>
                </td>
                <td class="second">
                </td>
            </tr>
        </table>
    </div>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    ALT :</h4>
                <p>
                    Alanine aminotransferase</p>
                <h4>
                    ALP :</h4>
                <p>
                    Alkaline phosphatase</p>
                <h4>
                    AST :</h4>
                <p>
                    Aspartate aminotransferase</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    GGT :</h4>
                <p>
                    Gamma glutamyl transferase (transpeptidase)</p>
                <h4>
                    LD :</h4>
                <p>
                    Lactate dehydrogenase</p>
                <h4>
                    PT :</h4>
                <p>
                    Prothrombin time</p>
            </div>
        </div>
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